CHAPTER 5 Nervous System^235
self-limiting. Fungal meningitis often occurs in patients who are immunocompro-
mised. Patients who have comorbidities or are elderly have greater difficulty with
the symptoms of meningitis.
HALLMARK SIGNS AND SYMPTOMS
- Stiff neck due to meningeal irritation and irritation of the spinal nerves
- Nuchal rigidity (pain when flexing chin toward chest) due to meningeal irri-
tation and irritation of the spinal nerves - Headache due to increased intracranial pressure
- Nausea and vomiting due to increased intracranial pressure
- Photophobia (sensitivity to light) due to irritation of the cranial nerves
- Fever due to infection
- Malaise and fatigue due to infection
- Myalgia (muscle aches) due to viral infection
- Petechial rash on skin and mucous membranes with meningococcal infection
- Seizures due to irritation of brain from increased intracranial pressure
INTERPRETING TEST RESULTS
- Lumbar puncture for cerebral spinal fluid analysis, glucose (bacterial low),
protein (bacterial elevated), cell counts (bacterial elevated neutrophils), and
culture. - Increased cerebral spinal fluid pressure noted.
- Polymerase chain reaction (PCR) test of cerebrospinal fluid to test for organ-
isms—results within a couple of hours. - Culture and sensitivity—results may take up to 72 hours.
- Blood cultures.
- CT scan brain to rule out space-occupying lesion as cause of symptoms.
TREATMENT
- Administer antibiotics as soon as possible to improve outcome for bacterial
meningitis:- penicillin G